Application For A Dealer Family Plate-Bureau Of Motor Vehicl Form Es

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Bureau of Motor Vehicles
Application for a Dealer Family Plate
(New, Used or Motorcycle Dealer Only)
(A separate application must be completed for each owner)
 New Car
 Used Car
 Motorcycle
Type:
Business Name: ______________________________________________Phone Number___________
Business Physical Location: ____________________________________________________________
City or Town: ________________________________________________Zip Code________________
Owner(s) Name(s) __________________________________________ Date of Birth_______________
Home Address:_______________________________________________________________________
Write the number of family plates you want to match the type of license you hold. Only one family plate
per owner. If an owner has ownership in any other dealership, he/she is allowed only one family plate
regardless of the number of dealerships owned. A family plate may be attached only to a vehicle in the
dealer’s active inventory for resale. A family plate may be used only by a spouse or child under the age of
19 residing full-time in the owners residence and may be used only for personal use, not for employment.
Type of Plate
Plate Fee
Total Fee
New Car Family
$20.00
New Car Vanity Family
$50.00
Used Car Family
$20.00
Motorcycle Family
$5.00
Total Amount(s)
Please list the family member(s) who may use the family plate:
Name_________________________________Date of Birth___________Relationship to owner_________
Home Address:_________________________________________________________________________
Name_________________________________Date of Birth___________Relationship to owner_________
Home Address: _________________________________________________________________________
Name_________________________________Date of Birth___________Relationship to owner_________
Home Address:_________________________________________________________________________
Add the total fees and submit your check or money order made payable to the Secretary of State to:
Bureau of Motor Vehicles, Dealer and Agent Services, 29 State House Station, Augusta, Maine 04333.
Payment may be made by credit card:
Type:
Visa
Mastercard
Number____________________
Expiration Date: __________________________
Name on Credit Card:_______________________________________
Signature of Owner
Official Title
Date
If you have any questions, please call Dealer and Agent Services at (207) 624-9000 Ext. 52143.
BMV Use Only
Date Initial License Issued: _________________________
Number of Sales for Renewal Year: __________________
Approval For Family Plates by: _______ Date: _________
MVD-356 (Rev. 7/12)
Denial For Family Plates by: ________ Date: __________
Reason For Denial: _______________________________

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